This form will speed up the process and we will not start any service request without proper authorization.

If you are having problems with this form please contact via e-mail or phone and a service representative will assist you. 
Email: servicebayshore@verizon.net                        Phone: 410-263-8370             Fax: 410-267-7354

SERVICE AUTHORIZATION

*Hourly rate: $125.00.  A deposit is required on all materials and special orders. 

**
Authorization: By clicking on I HERBY AUTHORIZE service box below you are HERBY AUTHORIZE as set forth above and agree to pay for parts, labor and other charges.
By clicking on I HERBY AUTHORIZE you understand 
that payment is due upon completion of the work and before you pick up the vessel.

You also understand and agree that you will owe 15% per annum interest on any unpaid balance.

By clicking on I HERBY AUTHORIZE you understand and agree to pay the attorney’s fees on any unpaid balance and interest.

You hereby grant a lien on the vessel to secure the payment of all charges, interest and attorney’s fees.


***
Please note:
If the invoice for the work requested by this Authorization is not paid within 30 days of the invoice date, the credit card listed here WILL be charged the amount due!

* denotes required field

Date:
Owner or Contact Person:*
Street Address:*
City:*
State:*
Email:
Zip Code:
Phone
Work
Home
Cell
Fax
Boat Model:*
Boat Name:*
Boat Location:*
Key Location or Combo*
Slip Number:*
Engine Information:
Engine:
Port:
Engine Hours:
Port:
STBD:
Engine Model:
Port:
STBD:
Engine Serial:
Port:
STBD:
Transmission Informaion:
Transmission:
Port:
Transmission Model:
Port:
STBD:
Transmission Serial Number:
Port:
STBD:
Generator:
Generator Hours:
Generator Model:
Generator Serial Number:
Generator SPEC:
Job Outline or Notes:
99999 characters remaining
Credit Card Information:
Name on Card:*
Card Number:*
Card Expiration: MM/YY*
Card Security Code:*
Authorization:_I HERBY AUTHORIZE(**See Note at the top of this page before clicking the box).*
*
Enter the code shown:

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